1. Field of the Invention
The present invention relates to surgical instruments and more particularly to an improved laparoscopic instrument for use in manipulating a curved needle in an area of limited access.
2. Background of the Related Art
Laparoscopy is the examination and surgical treatment of the interior of the abdomen by means of a laparoscope. The laparoscope is an instrument comparable to an endoscope, which is introduced surgically through the abdominal wall for examining the intra-abdominal organs. The most common uses of laparoscopy are for diagnosis of intra-abdominal diseases and for operations that require cholecystectomy, hernia repairs, adhesiolysis, hysterectomy, oophoresectomy, colectomy, and many other surgical procedures.
Various laparoscopic procedures involve the cutting and suturing of internal tissue. The suturing in laparoscopic procedures is difficult since the needle must be manipulated in an area of limited access with only two dimensional views. It is important that the curved needle commonly used in these procedures is maintained in the proper orientation in order to facilitate suturing. Also, the needle must be held securely because as needles enter tissues, they are often deflected sideways and turned.
Various instruments have been designed to accomplish these requirements, however, each contains disadvantages inherent in their design making them difficult to use. For example, U.S. Pat. No. 4,597,390 discloses a surgical needle manipulator. This device includes a tube with a telescopic rod inside the tube. Both the tube and rod have a diametrical slot at one end forming a bifurcated slot. The tube and rod are relatively rotatable resulting in the two slots being movable in and out of alignment. When the slots are in alignment, the shank of the needle can be received in the slots. As the slots are moved out of alignment, the needle is grasped by the side walls of the slots. This instrument, however, does not provide a very secure means for grasping the needle. Also, it is difficult in the confined work space to place the needle in the diametrical slots at the end of the tube and rod to facilitate grasping the needle. If the needle is inadvertently released or dropped within the patient, it is virtually impossible to pick up the needle with this instrument or replace it in the proper orientation. Also, while attempting to retrieve the needle with this instrument inside of the body cavity of the patient the surgeon may damage surrounding tissues.
In a Cook Incorporated publication, OECS291 (1991), an "Endoscopic Curved Needle Driver" is disclosed. This device consists of a long hollow cylindrical shaft with a "U" shaped handle at one end and a needle holding section at the other. At the handle end is a rotatable knob which secures the needle within the needle holding section. The Cook device also has a design which makes it difficult to re-grasp a needle during the suturing process. The needle holding section is made up of a grooved area near the end of the cylindrical shaft. If the needle is dropped, or its orientation has been changed while inside of the patent it would be virtually impossible to retrieve or reposition the needle with this device. Also, the needle holding section is positioned a small distance (about 1-2 cm) from the tip of the cylindrical shaft. Tissue surrounding the area to be sutured may be damaged by the protrusion of the cylindrical shaft beyond the point at which the needle is held.
Similarly, U.S. Pat. No. 3,871,379 discloses a combined laparoscopic needle and forceps consisting of an elongated parallelogram type linkage, means for mounting a needle at the end of the device and a forcep construction including a jaw mounted proximate to the holder for the needle. This patent also discloses a similar device in which the jaw contains a groove associated with the jaws for receiving a suture to act as a suture guide, and a cutting means mounted on the jaws for cutting a suture. The parallelogram construction of the '379 patent does not allow this device to be used within a laparoscopic tube, nor does it provide a secure grip on the suture needle. Also, if the suture needle is dropped, the design does not facilitate retrieving the needle.
U.S. Pat. No. 4,491,135 discloses a surgical needle holder for curved needles comprised of movable gripping jaws offset from a manipulating handle by a distance substantially equal to the radius of curvature of the surgical needle. The device uses a parallelogram type of linkage to open and close the jaws. The linkage and offset jaws are too large to fit within a surgiport during laparoscopic surgery and therefore cannot be utilized in such procedures.
Curved needle holders for external surgical procedures have been disclosed in U.S. Pat. No. 697,292; U.S. Pat. No. 1,445,348; and U.S. Pat. No. 3,120,847. Each of these patents discloses a scissor or forcep configuration containing a groove or notch in the jaws of the instrument. The notch of the '292 patent prevents breakage of the needle due to the pressure exerted by the jaws. The grooves of the '348 and '847 patents allow griping of the needle such that the needle may be oriented in a variety of positions to facilitate suturing. Since the scissor or forcep configuration is used, each of these surgical instruments are specifically designed for external surgical procedures. The handles of these instruments cannot fit within a laparoscopic tube and therefore cannot be used for laparoscopic suturing. If these instruments were used for internal surgical procedures they may cause ripping or tearing of the surrounding tissue due to the width of the handles.
Therefore, based on existing instrumentation for laparoscopic surgery, there is a need for a laparoscopic instrument which (1) can easily grasp a needle, release the needle, and again grasp the needle, even if the needle is accidently dropped by the surgeon (2) orients the needle in the upright position to facilitate suturing, and (3) provides maximum holding pressure when holding the suture.
It is therefore a purpose of the present invention to provide a laparoscopic instrument which self-orients a curved surgical needle in an upright position to facilitate ease in suturing.
Another purpose of the present invention is to provide a laparoscopic instrument which can easily grasp, release, and re-grasp a curved surgical needle and place the needle in a correct orientation for suturing.
Still another purpose of the present invention is to provide a laparoscopic needle holding instrument with a substantial mechanical advantage with respect to the force applied to the instrument handles and the resulting force applied at the instrument jaws to securely hold the curved surgical needle.
A further purpose of the present invention is to provide a new method of suturing in laparoscopic surgery utilizing the self-orienting laparoscopic needle holder for curved needles.
Yet another purpose of the present invention is to provide a self-orienting laparoscopic needle holder instrument which is easy to manufacture, yet is strong and durable.
Another purpose of the present invention is to provide an improved laparoscopic instrument which enhances the ability to suture during laparoscopy.
It is a further purpose of the present invention to provide a self-orienting laparoscopic curved needle holder which is easily manipulated by one hand and is rapidly engageable and disengageable.